Awake brain surgery for language mapping in pediatric patients: a single-center experience

Area of Science:

• Pediatric Neurosurgery
• Epileptology
• Neuro-oncology

Background:

• Awake brain surgery (ABS) is established for intraoperative language monitoring in adults.
• Reports on ABS in pediatric populations are limited.
• Structural epilepsies often require complex surgical interventions near eloquent brain areas.

Purpose of the Study:

• To assess the feasibility, benefits, and safety of ABS with intraoperative language mapping in children and adolescents.
• To evaluate language outcomes and seizure control after ABS for structural epilepsies.
• To investigate the role of electrocorticography (ECoG) and afterdischarge potentials (ADP) in pediatric ABS.

Main Methods:

• Retrospective chart review of pediatric patients (≤18 years) undergoing ABS and cortical language mapping (2008-2019).
• Evaluation of neuropsychological testing, intraoperative compliance, ECoG-assisted language mapping, and postsurgical outcomes.
• Descriptive statistics were used with a significance level of p < 0.05.

Main Results:

• Eleven children (median age 13) underwent ABS for lesions near language areas; 9 had refractory epilepsy.
• High intraoperative compliance was observed in 10/11 patients.
• Gross-total resection was achieved in 91%, with 100% seizure freedom at median 4.3-year follow-up. No postoperative language deficits were observed.
• Cortical mapping identified eloquent areas in 60%; ECoG revealed ADP in 56% of patients with speech disturbances, none experiencing postoperative language dysfunction.

Conclusions:

• ABS is a valuable technique for selected pediatric patients with lesions in or near language areas.
• Successful outcomes depend on an interdisciplinary approach, careful patient selection, preoperative training, and interpretation of intraoperative findings like ADP.
• The study demonstrates the safety and efficacy of ABS in improving language function and seizure control in pediatric epilepsy surgery.